Maryn McKenna

Journalist and Author

MRSA in meat: How much? Which? And more bad news.

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(Sorry for the radio silence, constant listeners. It’s been a challenging few weeks at Casa Superbug, with a death in the family and the chaos afterward of catching up to the rest of life. But back now, with some interesting stuff planned for later this week.)

Last week was the General Meeting of the American Society for Microbiology (ASM). This is the conference at which, several years ago, Tara Smith’s team at the University of Iowa first announced they had found MRSA ST398 in pigs in the United States, so it always bears watching for new MRSA news, and this year it didn’t disappoint.

First: I’ve complained persistently because the federal system that monitors antibiotic-resistant bacteria in animals and food, NARMS (National Antimicrobial Resistance Monitoring System) doesn’t include MRSA among the pathogens that it tracks. It is possible that might be changing — because at ASM, a team from the Food and Drug Administration reported the results of a pilot study that looked for MRSA in retail meat in the US and found it.

[Read more…]

Growth Promoters: If You Can't Convince Them, Sue Them

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A little less than a year ago, the Food and Drug Administration took a step that, depending on your point of view, was either far too activist or nowhere-near-enough-but-good-try: It proposed, in a draft document, that the agricultural industry voluntarily restrict its use of growth-promoting micro-doses of antibiotics.

It was a significant step. The FDA has been trying to restrict subtherapeutic use of antibiotics in livestock since the 1970s because of the practice’s clear contribution to the development of antibiotic resistance, and had always been defeated. At the same time, it was far from bold: The proposal was made in a draft document that would be made final at some unspecified future date, and that when it became final would have behind it no force of regulation or law. (Here’s my long discussion from last year of the context and history of FDA’s move.)

And there things rested, while the FDA’s docket reportedly filled up with thousands of comments from both sides of the issue. The document — formally, Draft Guidance #209, Judicious Use of Antimicrobial Drugs in Food-Producing Animals — is scheduled to be finalized sometime before the end of this year. But in its draft form, it excited abundant opposition, and the administration official who seemed to be leading the charge on it, memorably suggesting, “We have the regulatory mechanisms and the industry knows that,” has left the FDA for a state-government job.

Clearly, things aren’t moving very fast. So today, a coalition of nonprofit groups attempted to get the issue jump-started: They sued.

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Farm Antibiotics: 'Pig Staph' in a Daycare Worker

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It’s been just about seven years since an alert epidemiologist in the Dutch town of Nijmegen identified an aberrant strain of MRSA, drug-resistant staph, in a toddler who was going in for surgery to fix a hole in her heart. The strain was odd because it didn’t behave normally on the standard identifying tests, and because it had an unusual resistance factor — to tetracycline, a drug that it should not have been resistant to, because the Netherlands had such low rates of MRSA that tetracycline wasn’t being used against the bacterium there.

Pursuing the source of the strain, researchers at Radboud University found it in the toddler’s parents and sister, and in the family’s friends. Not knowing where else to look, they asked what the parents and their friends did for a living; discovered they were all pig farmers; and went to their farms, and checked the pigs, and found it being carried by them, too. Suddenly, that strange resistance pattern made sense: The Netherlands uses more antibiotics in pig agriculture than any other country in the European Union, and the drug that it uses the most is tetracycline. Clearly, the aberrant strain — known as MRSA ST398 for its performance on a particular identifying test — at some point had wandered into pigs, become resistant to the drugs being given to the pigs, and then crossed back to humans, carrying that new resistance factor as it went.

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Turning grief into action: Moms and antibiotic misuse

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In December 2007, I flew to Chicago to meet the team of researchers who spotted the first known cases of community-associated MRSA in the US in the mid-1990s, and who have been agitating ever since for recognition and action to beat back the rising tide of antibiotic resistance. It was grey and snowy outside their shabby suite of offices, carved out of University of Chicago’s long-replaced children’s hospital. I sat in a green-tinged conference room piled with stacks of articles while Everly Macario — a Harvard-trained ScD in public health, the daughter and sister of physicians — described how MRSA killed her toddler son Simon in less than 24 hours.

“We have no idea where he got it,” she told me. “We have no idea why he was susceptible.”

Simon Sparrow was 17 months old in April 2004, a big, sturdy child with no health problems except a touch of asthma. The day before he died, he woke up feverish and disoriented, startling his parents with a cry unlike anything they had heard from him before. It was a busy morning — his older sister had a stomach virus — but they got him to the pediatric ER, got him checked, and brought him home when doctors found nothing unusual going on.

A few hours later, Everly was working at home, watching both kids, and Simon’s breathing changed. Her husband James, a history professor, had driven a few hours away to give a speech. She called a friend who is a pediatrician, held the phone up to Simon’s nose and mouth so she could hear, and then got back on the line.

“Hang up,” her friend said. “Call 911.” [Read more…]

The biggest foodborne-disease threat may not be addressed by the new food-safety law

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So if we wanted to reduce the danger of pathogens passing to people via food — not just drug-resistant bacteria, which are an increasingly significant problem, but all disease-causing ones — where to start?

Formulating a strategy is more difficult than it seems. In the US, policing food safety is divided among several federal agencies: the FDA, USDA and CDC. The FDA has responsibility for most of the food supply, including seafood, produce, processed food and fresh eggs. The USDA’s Food Safety and Inspection Service (FSIS) regulates fresh meat and poultry and egg products. The CDC surveys the illnesses that result from any of them, estimating most recently that one in six US residents, or about 48 million people, get sick each year, 128,000 are hospitalized and 3,000 die.

But most of those illnesses are never investigated, because a substantial portion of them occur individually or in small clusters, not in major outbreaks. Many of them have long-term consequences that are never recorded by any federal counting mechanism. And there’s currently no surveillance system that links pathogens and food — which means there’s no way to target which foods, or food-raising practices, pose the greatest risks.

The new food-safety bill, signed in January, addresses at least some of those barriers, by requiring a risk-based approach to foodborne illness — meaning, you look at what is causing the greatest problem, and aim your efforts and funding in that direction. But the bill — which certain Congressmen have threatened to starve of funding — covers primarily the FDA. And a new analysis suggests that’s not where the greatest problems lie. [Read more…]

Multi-Drug Resistant Staph in 1 in 4 Meat Samples

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Much of the contentious debate over abuse of antibiotics in farming boils down to a couple of simple questions: Whether resistant organisms that arise on farms because of antibiotic use leave the farm, and whether, once they do, they reach human beings.

A piece of research due to be released this morning in the journal Clinical Infectious Diseases helps answer both those questions. (I received an advance copy under embargo; I’ll put up the link when the journal posts it. here’s the link to the full-text pdf.)

A team of researchers from Arizona bought meat and poultry in five cities across the United States, tested them for bacteria, and found this: 47 percent of the samples contained the very common pathogen Staphylococcus aureus, and 96 percent of those isolates were resistant to at least one antibiotic. Of more concern: 52 percent of those staph isolates were resistant to at least three antibiotics that are commonly used in both veterinary and human medicine.

That is: Roughly one in four packages of meat and poultry from across the United States contained multidrug resistant staph. [Read more…]

The Enemy Within: A new superbug, KPC/CRKP

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Remember NDM-1, the “Indian supergene” that created a media furor last fall and then fell below the news horizon? This is worse.

I have a story in the April Scientific American (“The Enemy Within,” just previewed online) about a new and very troubling form of antibiotic resistance: Carbapenem resistance, spreading through Gram-negative bacteria such as Klebsiella (above, from the CDC) and E. coli.

Carbapenems are drugs of last resort for Gram-negatives, which include many of the bacteria that cause potentially deadly infections in debilitated ICU patients and frail elderly in nursing homes. Gram-negatives have been becoming ever-more resistant to antibiotics, but the carbapenems remained reliable drugs of last resort for even the most serious cases. Then, in 1996, researchers at the Centers for Disease Control and Prevention spotted the first signal that carbapenems were under threat: A single bacterial sample, found in a patient in a North Carolina hospital, that was resistant to the carbapenems and could only be treated by a few remaining drugs that were much less effective or so toxic that medicine had put them on the shelf years ago.

By 2000, that same resistance pattern surfaced in hospitals in Manhattan: first one, then another, then a third and fourth. Then it began to spread to cities where New Yorkers vacation, and then to countries where they travel. Now, more than a decade later, it has reached at least 37 states and at least a dozen countries around the world.

It is spreading much faster than drugs to combat it could be developed — if there were such drugs. One of the difficulties, indeed tragedies, of carbapenem resistance is that there are very few such drugs left — because, for reasons I’ve explored before, drug development in the United States has ground to a halt. For resistant Gram-negatives, there are almost no drugs left, and none on the immediate horizon. If that scares you, well, it should.

Here’s a quick snip from the article:

The end of the antibiotic miracle is not a new theme. For as long as there have been antibiotics, there has been antibiotic resistance: The first penicillin-resistant bacteria surfaced before penicillin was even released to the marketplace in the 1940s. And for almost that long, doctors have raised the alarm over running out of drugs, sparked by the global spread of penicillin-resistant organisms in the 1950s and followed by methicillin resistance in the 1980s and vancomycin resistance in the 1990s.

This time, though, the prediction of post-antibiotic doom comes from a different part of the microbial world. The genes that confer carbapenem resistance have appeared over the past decade or so in a particularly challenging grouping of bacteria called gram-negatives.

Gram-negative bacteria are promiscuous: They facilely exchange bits of DNA, so that a resistance gene that arises in Klebsiella, for example, quickly migrates to E. coli, Acinetobacter and other gram-negative species. Gram-negative germs are also harder to dispatch with antibiotics because they have a double-layered membrane that even powerful drugs struggle to penetrate, and possess certain internal cellular defenses as well. In addition, fewer options exist for treating them. Pharmaceutical firms are making few new antibiotics of any type these days. For the protean, stubborn gram-negatives, they have no new compounds in the pipeline at all.

Carbapenem resistance has already brought hospital-acquired infections to the brink of untreatable. The imagined future that keeps health authorities awake at night is the undetected dissemination of carbapenem resistance genes into organisms that cause everyday maladies—such as E. coli, which is responsible for most of the millions of urinary tract infections in the U.S. every year.

Carbapenem resistance in Klebsiella — which is sometimes called KPC or CRKP for short — got a spike of attention last week just as my piece hit the web. Coincidentally, the article posted just as the Los Angeles County Department of Public Health released results of a survey showing 356 cases just between June and December 2010 just in LA County medical facilities.

This SciAm piece is the first that we know of to tell the whole tangled, troubling story. I hope you’ll take a look.

And while you’re there, please read SciAm’s brave and cogent editorial against antibiotic overuse in industrial-scale agriculture. It’s marvelous.

CDC Public Health Image Library

China pig crisis: Drug residues in pork

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In China, more than 2,000 tons of fresh pork and pork products — at a minimum, 4 million pounds — have been recalled because the meat has tested positive for clenbuterol, a stimulant that is illegal in food-producing animals not only in China but in Europe and the United States. Another 1.6 million pigs are being tested.

The story has been unfolding for the past week without much notice from Western media, but it has been heavily covered in China, even in English-language media there.

Clenbuterol, which lingers in muscle tissue for months and concentrates in some organs, is hazardous to humans because of its stimulant properties: It revs up the heart and gives you the shakes, and can be especially dangerous for pregnant women. (Here’s the data sheet from the Food Safety and Inspection Service.) If it sounds familiar, that’s because its stimulant qualities also make it a performance enhancer — and thus a banned drug for elite athletes, including a listing on the World Anti-Doping Agency’s Prohibited List. Tour de France winner Alberto Contador was temporarily banned from cycling this year after a positive clenbuterol test, and US Olympic swimmer Jessica Hardy was found positive for the drug in 2008 (a finding she blamed on an allegedly tainted supplement). Clenbuterol’s a common subject on body-building forums (here’s one example) for its perceived ability to build lean muscle while diminishing fat.

And that may have been the motivation in China: putting lean weight, inexpensively, on pigs.

Here’s what’s known:

On March 17, the Chinese TV network CCTV reported that 19 pigs at a slaughterhouse in Henan province, part of a lot of 689, had tested positive for clenbuterol in their urine. About 20 people — farmers, middlemen, quarantine inspectors and a buyer for the processing company, Jiyuan Shuanghui Food Co., Ltd. — were arrested.

On March 18, Xinhua News reported that the number of positive tests had grown to 52 pigs out of 1,512, on nine farms tested, and the number of people in police custody had grown to 30. Plus, the scandal had spread to a second province, Jiangsu, after 20 randomly picked pigs out of 264 from Henan tested positive at a slaughterhouse in Nanjing. Concern over the brewing scandal drew the central government’s Ministry of Commerce into the issue; the agency urged the company where the tainted pork was first found — which happens to be a subsidiary of China’s largest meat processor — to suspend production and start an internal investigation.

On March 19, the central government convened an emergency meeting of pig farmers, meat processors and food retailers, and two days later ordered provincial authorities to start a crackdown that extends to checking backyard pigs.

And on March 25, the government released its annual food safety plan and put special emphasis on banning clenbuterol and tracking down illegal users.

Notably, the more-free parts of the Chinese media are pushing the government to do more. China Daily editorialized on Thursday:

Why can’t quarantine workers go to pig farms in a random way to check the pigs? Why do they have to wait for the pig urine sent by pig raisers? Why aren’t pigs randomly checked immediately before they are butchered? What is both funny and sad is the fact that a local bureau of animal husbandry in central China’s Henan Province checked a problematic pig farm and 98.8 percent of the pigs tested were passed safe on March 15. But an investigation by reporters after the check found that the farm still feeds pigs clenbuterol, which was banned nine years ago.

The revelation that pigs are being fed growth hormones that are considered harmful to humans so the animals develop more muscle and less fat has shaken consumers’ confidence in pork, just as the melamine scandal did with milk. Anyone involved, whether pig raisers or quarantine checkers, must be brought to justice…

The general public wants to be told how problematic pigs can pass a series of tests before they are butchered and how the meat containing harmful substances can go through a series of tests and still end up in the mouths of consumers.They also want to know whether the culprits, including pig raisers who have fed pigs harmful chemicals and those who took money to turn a blind eye to the problematic pigs and meat will get the punishments they deserve.

This isn’t the first time clenbuterol has been found in pork in China. In 2009, 70 people in Guangdong province were hospitalized for stimulant poisoning after eating organ meats from contaminated pigs; in 2006, more than 300 people in Shanghai were sickened. In January, two months before this scandal surfaced, the AP’s Alexa Olesen wrote a prescient long takeout on the complexity of controlling clenbuterol abuse, especially in rural areas.

Here’s a question: Activism for safe food in the United States was arguably ignited by Upton Sinclair’s The Jungle, a novel that served as an expose of the contamination and filthy conditions he witnessed working undercover in Chicago’s meatpacking plants. There was such a public outcry at his revelations that the Pure Food and Drug Act of 1906, the first US food-safety legislation, was written and passed in the same year the book came out. The Jungle was so influential that, 105 years later, it is still in print.

I wonder: Who will write a Jungle for China? And given the repression that seems to be practiced against whistleblowers there, if anyone did, would it see print?

Flickr/JulianPTan/CC

Diseases and borders: Potatoes and St. Patrick's Day

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Beannachtai lá le Pádraig, constant readers — or, for you English-speaking lot, Happy St. Patrick’s Day.

In Irish, the way to say “Once upon a time” is O fadó fadó — “Long, long ago…” So, for St. Patrick’s Day, an Irish story:

Long, long ago — or, by the calendar, in 1824 — the territory know as Peru broke Spain’s last hold on the New World. The nascent Republic needed trade relationships, and quickly: It had borrowed heavily from banks in Europe to finance its 3-year war of independence. But after 300 years of colonization, all it had to offer, bluntly, was crap.

No, really, crap. Bat and seabird crap, otherwise known as guano. In the centuries before the establishment of the chemical industry, guano was a precious commodity, a potent natural fertilizer packed with nitrate and phosphates. There were enormous deposits of guano on the Andean coast and offshore islands; they provided the currency that Peru’s new government leveraged into a web of trade relationships with England, the United States, and France. Guano quickly became Peru’s leading export and the basis of its entire economy. In 1841, the government nationalized the guano deposits, selling the stuff to its European and American partners in hundreds of shiploads — tens of thousands of tons — per year. [Read more…]